title: Opened end-to-side technique for end-to-side anastomosis and analyses by an elastic true-to-scale silicone rubber model.
abstract: The end-to-side anastomosis is frequently used in microvascular free flap transfer, but detailed rheological analyses are not available. The purpose of this study was to introduce a new modified end-to-side (Opened End-to-Side, OES-) technique and compare the resulting flow pattern to a conventional technique. The new technique was based on a bi-triangulated preparation of the branching-vessel end, resulting in a "fish-mouthed" opening. We performed two different types of end-to-side anastomoses in forty pig coronary arteries and produced one elastic, true-to-scale silicone rubber model of each anastomosis. Then we installed the transparent models in a circulatory experimental setup that simulated the physiological human blood flow. Flow velocity was measured with the one-component Laser-Doppler-Anemometer system, recording flow axial and perpendicular to the model at four defined cross-sections for seven heart cycles in each model. Maximal and minimal axial velocities ranged in the conventional model between 0.269 and -0.122 m/s and in the experimental model between 0.313 and -0.153 m/s. A less disturbed flow velocity distribution was seen in the experimental model distal to the anastomosis. The OES-technique showed superior flow profiles distal to the anastomosis with minor tendencies of flow separation and represents a new alternative for end-to-side anastomosis.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum rechts der Isar, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mücke
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Ritschl
authors.forename: Andrea
authors.initials: A
authors.lastname: Balasso
authors.forename: Klaus-Dietrich
authors.initials: KD
authors.lastname: Wolff
authors.forename: David A
authors.initials: DA
authors.lastname: Mitchell
authors.forename: Dieter
authors.initials: D
authors.lastname: Liepsch
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D008953:Models, Anatomic; D012039:Regional Blood Flow; D012826:Silicone Elastomers; D013552:Swine; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: D012826:Silicone Elastomers